Social Determinants Related to GI Nutrition Survey

Question Title

* 1. The Social Determinants Related to GI Nutrition survey project was approved by the University of Michigan's Internal Review Board (IRB). The IRB number is HUM000198152. The anonymous survey (approximately 5 minutes) investigates how nutrition impacts GI disorders. By selecting Yes to this question, it will indicate informed consent to participate in this project. Selecting No, the survey will close.

Yes

Question Title

* 2. Have you been diagnosed with Irritable Bowel Syndrome?

Yes

Question Title

* 3. What is your primary Irritable Bowel Syndrome complaint?

Constipation

Diarrhea

Constipation and Diarrhea

Question Title

* 4. Gender

Male

Female

Question Title

* 5. What is your zip code?

Question Title

* 6. Ethnicity, what is your race?

Caucasian

African-American

Latino or Hispanic

Asian

Native American

Native Hawaiian or Pacific Islander

Middle Eastern

Question Title

* 7. How many family members, including yourself, do you currently live with?

Question Title

* 8. What is your housing situation today?

I have housing

I do not have housing (staying with others; in a hotel; living in a shelter; living outside on the street, on a beach, in a car, or in a park)

I choose not to answer

Question Title

* 9. Are you worried about losing your housing?

Yes

I choose not to answer this question

Question Title

* 10. What is the highest level of school that you have finished?

Less than high school disagree

High school diploma or GED

More than a high school diploma or GED

I choose not to answer this question

Question Title

* 11. What is your current work situation?

Unemployed

Part-Time or Temporary Work

Full-Time

Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)

I choose not to answer this question

Question Title

* 12. What is your main insurance?

None/Uninsured

CHIP Medicaid

Other Public Insurance (not CHIP)

Private Insurance

Medicaid

Medicare

Question Title

* 13. During the past year, what was the total combined income for you and the family members you live with?

$0.00 - $24,999

$25,000 - $49,999

$50,000 - $74,999

$75,000 - $99,999

$100,000 - $199,999

Greater than $200,000

I choose not to answer this question

Question Title

* 14. In the past year, have you or any family member you live with been unable to get food when it was really needed?

Yes

Question Title

* 15. In the past year, have you or any family member you live with been unable to get utilities when it was really needed?

Yes

Question Title

* 16. In the past year, have you or any family member you live with been unable to get clothing when it was really needed?

Yes

Question Title

* 17. In the past year, have you or any family member you live with been unable to get childcare when it was really needed?

Yes

Question Title

* 18. In the past year, have you or any family member you live with been unable to get medicine or healthcare (medical, dental, mental health, vision) when it was needed?

Yes

Question Title

* 19. In the past year, have you or any family member been unable to get a phone when it was really needed?

Yes

Question Title

* 20. Has a lack of transportation kept you from medical appointments, meetings, work, or from getting things for daily living (check all that apply)?

Yes, it has kept me from medical appointments

Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need

I choose not to answer this question

Question Title

* 21. Within the past 12 months, we worried whether our food would run out before we got money to buy more: this statement is

Often True

Sometimes True

Never True

Question Title

* 22. Within the past 12 months, the food we bought just didn't last and we didn't have money to get more. This statement is

Often True

Sometimes True

Never True

Question Title

* 23. Is it easy for you to get to a local grocery store?

Yes

Question Title

* 24. Do you have fresh fruits and vegetables to purchase near your home?

Yes

Question Title

* 25. Has a healthcare provider ever recommended a low FODMAP diet to help treat gastrointestinal symptoms? (symptoms including diarrhea, bloating, abdominal pain, constipation, nausea, vomiting, hear burn, fecal incontinence, etc)?

Yes

Question Title

* 26. Have you ever considered starting a low FODMAP diet to help treat gastrointestinal symptoms on your own? (symptoms including diarrhea, bloating, abdominal pain, constipation, nausea, vomiting, heart burn, fecal incontinence, etc.)

Yes

Not Applicable

Question Title

* 27. Have you visited with a registered dietician to learn about the low FODMAP diet?

Yes

Not Applicable

Question Title

* 28. What resources did you use to help guide you on a low FODMAP diet? (please check all that applies)

Monash App

Other Diet App

Handout

Google Search

Dietician

Medical Provider (Physician, Physician Assistant, or Nurse Practitioner)

Nurse

Question Title

* 29. The low FODMAP diet helped my Irritable Bowel Syndrome symptoms?

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

I have not tried the low FODMAP diet

Question Title

* 30. I did not try the low FODMAP diet because

It was too limited

I could not afford it

I prefer to use another treatment for my Irritable Bowel Syndrome

It is too hard to understand

Not Applicable

Question Title

* 31. Does anyone else in your family have to follow a special diet?

Yes